Exercise for People Living with HIV: Difference between revisions

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* Do at least '''150-300min''' of '''moderate-intensity aerobic''' physical activity OR '''75-150min''' of '''vigorous-intensity aerobic''' physical activity per week <ref name=":3" />
* Do at least '''150-300min''' of '''moderate-intensity aerobic''' physical activity OR '''75-150min''' of '''vigorous-intensity aerobic''' physical activity per week <ref name=":3" />
* Also do '''muscle-strengthening''' activities at moderate or greater intensity that involve all major muscle groups, '''2 or more days''' per week <ref name=":3" />[[File:Infographic_on_WHO_guidelines_for_physical_activity.jpg|alt=|thumb|600x600px|WHO physical activity guidelines<ref>WHO. 2021, June 7. WHO guidelines on physical activity and sedentary behaviour. Available from: https://www.who.int/multi-media/details/who-guidelines-on-physical-activity-and-sedentary-behaviour</ref>]]
* Also do '''muscle-strengthening''' activities at moderate or greater intensity that involve all major muscle groups, '''2 or more days''' per week <ref name=":3" />
* When not contra-indicated, increase moderate-intensity aerobic physical activity to more than 300min, or vigorous physical activity to more than 150min<ref name=":3" />  
* When not contra-indicated, increase moderate-intensity aerobic physical activity to more than 300min, or vigorous physical activity to more than 150min<ref name=":3" />  
* Older adults should also engage with  weekly functional balance and strength training '''3 days''' per week, to prevent falls and improved functional capacity<ref name=":3" />
* Older adults should also engage with  weekly functional balance and strength training '''3 days''' per week, to prevent falls and improved functional capacity<ref name=":3" />
* When these guidelines can't be met, PLWH should aim to engage with physical activity to the best of their abilities and follow a process of gradual introduction as health status and capacity allow <ref name=":3" />  
* When these guidelines can't be met, PLWH should aim to engage with physical activity to the best of their abilities and follow a process of gradual introduction as health status and capacity allow <ref name=":3" />  
* The WHO also emphasises that the above guidelines are not applicable when undergoing acute treatment, if any contra-indications are present or when not medically stable <ref>WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. EXECUTIVE SUMMARY. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK566048/</nowiki></ref>.
* The WHO also emphasises that the above guidelines are not applicable when undergoing acute treatment, if any contra-indications are present or when not medically stable <ref>WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. EXECUTIVE SUMMARY. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK566048/</nowiki></ref>.
 
[[File:Infographic_on_WHO_guidelines_for_physical_activity.jpg|alt=|thumb|600x600px|WHO physical activity guidelines<ref>WHO. 2021, June 7. WHO guidelines on physical activity and sedentary behaviour. Available from: https://www.who.int/multi-media/details/who-guidelines-on-physical-activity-and-sedentary-behaviour</ref>|none]]


Click here to access the booklet: [https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf WHO guidelines booklet]
Click here to access the booklet: [https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf WHO guidelines booklet]

Revision as of 22:38, 15 April 2023

Original Editor - Audrey Brown

Top Contributors - Melissa Coetsee, Kim Jackson, Audrey Brown and Lucinda hampton  

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (15/04/2023)

Introduction[edit | edit source]

Since the introduction of antiviral therapy, the prognosis of people living with HIV (PLWH) has greatly improved[1]. This has however led to new challenges relating to the chronicity of HIV and the long term effects of the disease and the side-effects of ART (Antiretroviral therapy).

Regular physical activity and exercise are part of a healthy lifestyle for everyone, including PLWH[2]. In 2020, the World Health Organisation (WHO) released revised physical activity recommendations, with additional considerations for people with chronic conditions, including HIV [3]. These recommendations made it clear that exercise is safe and beneficial for PLWH.

Considerations for People Living with HIV[edit | edit source]

PLWH may have a variety of psychological and physiological symptoms associated with the virus itself, the related medications, or a combination of both[1]. Due to these factors, there is need for special considerations when it comes to physical activity and exercise. PLWH often present with significant reductions in their general well-being and overall quality of life, with an interplay of various complex factors contributing to this.

1. WHO guidelines[edit | edit source]

People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV. The WHO guidelines recommends that PLWH should engage in regular physical activity, because:

  • It can improve physical fitness and mental health
  • It does not have any negative effects on CD-4 counts or body composition [3]

It is recommended that PLWH should:

  • Do at least 150-300min of moderate-intensity aerobic physical activity OR 75-150min of vigorous-intensity aerobic physical activity per week [3]
  • Also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups, 2 or more days per week [3]
  • When not contra-indicated, increase moderate-intensity aerobic physical activity to more than 300min, or vigorous physical activity to more than 150min[3]
  • Older adults should also engage with weekly functional balance and strength training 3 days per week, to prevent falls and improved functional capacity[3]
  • When these guidelines can't be met, PLWH should aim to engage with physical activity to the best of their abilities and follow a process of gradual introduction as health status and capacity allow [3]
  • The WHO also emphasises that the above guidelines are not applicable when undergoing acute treatment, if any contra-indications are present or when not medically stable [4].
WHO physical activity guidelines[5]

Click here to access the booklet: WHO guidelines booklet

2. Health considerations and risks[edit | edit source]

People living with HIV may exhibit metabolic changes with negative health implications. Some of these changes include increased blood lipids, central fat accumulation, lipodystrophy, and decreased aerobic capacity.[1]

3. Barriers to Exercise[edit | edit source]

4. ART side-effects[edit | edit source]

Symptoms of HIV and treatment-related toxicities may include:[1]

  • Impaired glucose tolerance
  • Increased fatigue
  • Increased blood lipid profile
  • Chronic inflammation
  • Anxiety
  • Depression
  • Circulating cortisol
  • Higher visceral fat levels[6]
  • Obesity

Benefits of Physical Activity[edit | edit source]

1. Psychological benefits[edit | edit source]

Mental Health

Quality of Life

Improved self-efficacy[7]

Social Engagement

2. Cardiorespiratory benefits[edit | edit source]

3. Haemodynamic effects[edit | edit source]

Regular exercise can also reduce the risk of cardiovascular disease, high blood pressure, type 2 diabetes, and cancer and may help reduce symptoms associated with the virus and negative treatment-related side effects. [2]

4. Immunological effects[edit | edit source]

CD4 count

Inflammation

5. Physical benefits[edit | edit source]

  • Maintains or builds muscle mass

Types of Exercise[edit | edit source]

1. Aerobic

2. Strengthening and resistance training

3. Balance and functional strengthening

Frequency of Exercise[edit | edit source]

Low-resource settings[edit | edit source]

HIV is most prevalent in low- and middle income countries. The WHO (African Region), reported that in 2018, almost two thirds of the global total of new HIV infections occur in Africa[8]. Despite this, most of the current literature on exercise for PLWH is based on research studies conducted in high-income settings. Many studies use gym equipment and stationary bicycles for the exercise regimes, which is not feasible in LMICs. The high infectious disease risk and other social determinants of health in LMICs, could also change the average baseline health status and abilities of PLWH. It could be that exercise could have even more dramatic benefits in LMICs, but affordable and health-appropriate exercise interventions will need to be considered.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Jaggers JR, Hand GA. Health Benefits of Exercise for People Living With HIV: A Review of the Literature. Am J Lifestyle Med. 2014;10(3):184-192. Published 2014 Jun 16. doi:10.1177/1559827614538750
  2. ↑ 2.0 2.1 https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Dempsey, P. C., Friedenreich, C. M., Leitzmann, M. F., Buman, M. P., Lambert, E., Willumsen, J., & Bull, F. (2021). Global public health guidelines on physical activity and sedentary behavior for people living with chronic conditions: A call to action. Journal of Physical Activity and Health, 18(1), 76–85. https://doi.org/10.1123/JPAH.2020-0525
  4. ↑ WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. EXECUTIVE SUMMARY. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566048/
  5. ↑ WHO. 2021, June 7. WHO guidelines on physical activity and sedentary behaviour. Available from: https://www.who.int/multi-media/details/who-guidelines-on-physical-activity-and-sedentary-behaviour
  6. ↑ Hand GA, Lyerly GW, Jaggers JR, Dudgeon WD. Impact of Aerobic and Resistance Exercise on the Health of HIV-Infected Persons. Am J Lifestyle Med. 2009;3(6):489-499.
  7. ↑ Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL. A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: a randomised controlled trial. Aust J Physiother. 2006;52(3):185-90.
  8. ↑ WHO Africa. HIV/AIDS. Available from: https://www.afro.who.int/health-topics/hivaids (accessed 15 April 2023)
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